1. it's highly contagious

2. it's a reportable dz

3. it causes acute bronchitis and should be tx w/ a macrolide antibiotic (1st line tx for acute bacterial bronchitis)

A 24 year old college student who is a non-smoker and otherwise healthy has been dx w/ pertussis. How should she be tx?

a. doxy 100mg BID x7d

b. azithromycin 500mg on day 1, 250mg days 2-5

c. augmentin 875mg BID x5d

d. tx sx

Which pneumonia bug?

Most commonly affects the elderly and kills more patients than any other pneumonia bug.

Which pneumonia bug?

Cause atypical pneumonia.

Which pneumonia bug?

Also known as "walking pneumonia" and affects young-middle aged adults.

Which pneumonia bug?

Chest XR is the gold standard for dx.

Which pneumonia bug?

Produces rust-colored sputum, high fever, cough, and pain in side/chest.

Which pneumonia bug?

Presents w/ a low-grade fever, cough, HA, malaise, joint pain, rash, and sometimes arrhythmias.

Which pneumonia bug?

Also called DRSP and is tx w/ a respiratory quinolone or a beta lactam + a macrolide or doxy.

Which pneumonia bug?

Tx w/ a macrolide or doxy.

A 54 y/o otherwise healthy pt who takes no meds has been dx w/ CAP. What's an appropriate tx for her?

a. levofloxacin 750mg daily x5d

b. azithromycin 500mg on day 1, then 250mg days 2-5

c. augmentin 875mg BID x5d

d. tx sx

A 55 y/o pt was dx w/ pneumonia 7 days ago and was started on levofloxacin. He is afebrile x2d but complains that he feels tired and is still coughing. How should he be tx?

a. order a CXR

b. continue atbx for 3 more days

c. start a diff atbx

d. have him continue to rest for 3-5 more days

Which characteristic is LEAST likely to prompt an NP to consider hospitalization for an adult who has been dx w/ pneumonia?

a. confusion since onset of sx

b. RR = 30/minute

c. BP 80/50

d. age = 55 y/o

Who needs the pneumococcal vaccine PPSV23?

a. everyone

b. adults 19-64 y/o who are part of a "vulnerable population"

c. only college freshman living in dorms

d. only adults >65 y/o

Who needs the pneumococcal vaccine PVC13?

a. everyone

b. adults 19-64 y/o who are part of a "vulnerable population"

c. only college freshman living in dorms

d. only adults >65 y/o

e. b and d

If you meet the criteria to receive the PCV13 vaccine, when should you receive the PPSV23 vaccine?

a. in 1 year

b. at the same time

c. you do not need this vaccine

d. 6 months

What are the 3 key dx factors for COPD?

a. dyspnea, chronic cough, chronic sputum production

b. dyspnea, pulmonary edema, chronic sputum production

c. chronic cough, pulmonary edema, chronic sputum production

d. chronic cough, dilated heart on CXR, pulmonary edema

Other than smoking, what are some other risk factors for developing COPD? (select all that apply)

a. occupational exposure to airway irritants

b. hx of asthma

c. living in an area w/ high levels of pollution

d. HF

e. TB

f. >40 y/o

What is required to establish a dx of COPD?

a. CXR

b. PFTs

c. spirometry

d. constellation of sx

What medication is first-line for COPD?

a. ICS

b. LABA

c. long-acting anticholinergic

d. short-acting anticholinergic

Put the COPD prescribing strategies in order from first-line to last-line.

1. ICS + LABA or LA anticholinergic, plus rescue med

2. LA anticholinergic or LABA, plus rescue med

3. SA anticholinergic PRN or SABA PRN

4. ICS + LABA + LA anticholinergic, plus rescue med

Which class of meds used to tx COPD?

Suffix is "terol"

Which class of meds used to tx COPD?

Suffix is "one" or "ide" and are best used in combination w/ bronchodilators.

Which class of meds used to tx COPD?

Considered a "rescue med" b/c they work immediately and last 4-6 hours.

Which class of meds used to tx COPD?

Should be used w/ caution in elderly pts d/t AEs and should be avoided in pts w/ glaucoma.

Which class of meds used to tx COPD?

Suffix is "tropium"

Which class of meds used to tx COPD?

Is not considered a rescue med b/c it take 10-20 minutes to work (lasts 12-24 hours, though).

Which class of meds used to tx COPD?

This is considered the best med for COPD pts w/ FEV1 <60% but is very, very expensive and cannot be afforded by all pts.

What is the recommended dose for oral steroids used to tx COPD exacerbations?

a. prednisone dose pack

b. steroid shot

c. prednisone 40mg daily x5d

prednisone 40mg daily x14d

Which type of asthma?

Sx occur daily, wake pt at night at least once weekly, and limit activities somewhat-extremely.

a. intermittent asthma

b. exercise induced asthma

c. mild persistent asthma

Which type of asthma?

Sx occur <2 days/wk, wake pt at night <2x/month, and do not interfere with normal activities.

a. intermittent asthma

b. exercise induced asthma

c. mild persistent asthma

d. moderate persistent asthma

Which type of asthma?

Sx occur >2 days/wk but NOT daily, wake pt at night 1-4x/mo, and nterfere with normal activities >2d/wk but NOT daily.

a. intermittent asthma

b. exercise induced asthma

c. mild persistent asthma

d. moderate persistent asthma

When should f/u for asthma take place if the pt is well-controlled?

a. q2-6wks

b. q1-6mos

c. q3mos

d. annually

When should f/u for asthma take place if the pt is trying to gain control?

a. q2-6wks

b. q1-6mos

c. q3mos

d. annually

When should f/u for asthma take place if the pt is monitoring their control?

a. q2-6wks

b. q1-6mos

c. q3mos

d. annually

When should spirometry take place if the pt is well-controlled?

a. q2-6wks

b. q1-6mos

c. q3mos

d. annually

What does EVERY asthma pt need? (select all that apply)

a. ICS

b. SABA

c. asthma action plan

d. spirometry

e. LABA

Which medication should NEVER be used alone to tx asthma d/t increased risk of sudden death?

a. ICS

b. SABA

c. LABA

d. none of these should be used alone

A 30 y/o pt who has asthma has used a low-dose steroid inhaler BID w/ good control for the past 3 months. In the last week, he has had to use his inhaler 2-3 times daily for wheezing. What is the best plan to help alleviate his sx?

a. add oral steroid daily x5d

b. add ipratropium (Atrovent) BID

c. increase steroid inhaler to medium dose

d. d/c the steroid, add a LABA

In which pt is a CXR indicated today?

a. 45 y/o smoker w/ possible acute bronchitis

b. 56 y/o w/ resolving pneumonia (dx 1 week ago)

c. 65 y/o w/ COPD in clinic for routine f/u appt

d. 75 y/o who feels well but has had a cough for 7 weeks

Asthma, COPD, or Both?

Consider ICS for first-line tx.

Asthma, COPD, or Both?

Anticholinergics usually relieve sx.

Asthma, COPD, or Both?

Disease is typically progressive.

Asthma, COPD, or Both?

Disease is usually present at young age.

Asthma, COPD, or Both?

LABA alone is safe.

Asthma, COPD, or Both?

Dx is usually made as an adult.

Asthma, COPD, or Both?

Needs a rescue inhaler.

A 24 y/o college student who is otherwise healthy has CAP dx via CXR 48 hours ago. She was given augmentin 875 BID for the past 48 hours. She is febrile w/ a decrease in temp from 103 to 102 after 48 hours. How should she be managed?

a. repeat CXR, order CBC

b. start levofloxacin

c. continue this plan for another 24 hours

d. stop augmentin and start doxy 100mg BID x7d

A 63 y/o pt w/ COPD c/o a pounding heart after taking his "inhaler." Which med is LEAST likely to cause this AE?

a. steroid

b. albuterol

c. ipratropium

d. salmeterol

A 24 y/o pt presents w/ white plaques on the buccal mucosa, palate, and tongue. Which med is the most likely reason for this?

a. PO levofloxacin

b. inhaled albuterol

c. inhaled fluticasone

d. inhaled ipratropium

A 78 y/o pt who smokes and who has COPD stage II presents w/ c/o nocturia and the sensation of incomplete emptying of his bladder. He is taking losartan 50mg/HCTZ 12.5mg, amlodipine 5mg daily, tamsulosin 0.8mg daily, atorvastatin 10mg daily, albuterol PRN, and tiotropium daily. How should he be handled?

a. refer to urology

b. increase tamsulosin to BID

c. stop tiotropium, add salmeterol

d. begin lifestyle modifications for urinary sx

A 30 y/o pt w/ moderate persistent asthma has a temp of 102, bilateral wheezes, mild SOB, and purulent sputum. She takes fluticasone/salmeterol (Advair) BID, albuterol PRN, amlodipine 5mg, levothyroxine 88mcg daily, and metformin 1000mg BID. How should she be managed?

a. order nebulized albuterol, tx w/ doxy

b. tx w/ cipro and nebulized ablbuterol q4-6h PRN

c. tx as acute bronchitis w/ oral steroids only

d. tx as pneumonia w/ levofloxacin and nebulized albuterol q4-6h PRN for wheezing

A 30 y/o pregnant pt w/ moderate persistent asthma has a temp of 102, bilateral wheezes, mild SOB, and purulent sputum. She takes fluticasone/salmeterol (Advair) BID, albuterol PRN, amlodipine 5mg, levothyroxine 88mcg daily, and metformin 1000mg BID. How should she be managed?

a. order nebulized albuterol, tx w/ doxy

b. tx w/ azithromycin 500mg on day 1, then 250mg days 2-5 + 1000mg amoxicillin BID

c. tx as acute bronchitis w/ oral steroids only

d. tx as pneumonia w/ levofloxacin and nebulized albuterol q4-6h PRN for wheezing

What are the 2 most common side effects of long-term ICS use?

a. OP and GERD

b. HTN and DM

c. hyperkalemia and DM

d. cataracts and osteopenia

Which type of anemia? (select all that apply)

MCV normal (80-96 fl).

a. IDA

b. thalaseemia

c. ACD

d. SCD

e. CA

f. pernicious/B12

g. folate deficiency

Which type of anemia? (select all that apply)

MCV low (<80 fl).

a. IDA

b. thalaseemia

c. ACD

d. SCD

e. CA

f. pernicious/B12

g. folate deficiency

Which type of anemia? (select all that apply)

MCV high (>96 fl).

a. IDA

b. thalaseemia

c. ACD

d. SCD

e. CA

f. pernicious/B12

g. folate deficiency

In a pt who appears to have "mixed anemia," what dx test is the most valuable?

a. CBC w/ diff

b. peripheral blood smear

c. Hgb electrophoresis

d. all of the above

if a TIBC is low, meaning that there are not many iron binding sites available at the moment b/c they are being occupied by iron, then you would expect the iron count to be high

***reciprocally, if the TIBC were high, meaning that there are many iron binding sites available, you would expect the iron count to be low

in a newly dx IDA pt, the RDW should be high (>15%) because the RBCs will be a mix of normocytic and microcytic

***in a pt w/ long-standing IDA, the body will have converted to making mostly microcytic RBCs so the difference in size will now be <15%

What anemia is this?

Microcytic, hypochromic, low iron, low ferritin, high TIBC.

What anemia is this?

Microcytic, hypochromic, normal iron, normal ferritin, normal TIBC.

True or false:

Both B12 and folate deficiencies can cause sx by themselves and can cause neuro changes, especially in the elderly.

Bacterial or viral:

Lymphocytes 43.1 (H) and neutrophils 46.5 (H).

Bacterial or viral:

Lymphocytes 2 (L) and neutrophils 81 (H).

What does an increased monocyte count typically indicate?

a. infection <12 hours

b. infection <24 hours

c. infection >24 hours

d. has nothing to do w/ duration of infection

What are the 2 most common sx of a brain tumor in a adult?

a. nausea and vomiting

b. HA and nausea

c. HA and seizure

d. tremors and weakness

Cause of notable fundoscopic finding:

Blood in center of optic disc.

a. cataract

b. increased ICP

c. glaucoma

d. papilledema

e. SAH

Cause of notable fundoscopic finding:

Swelling of the optic disc.

a. cataract

b. increased ICP

c. glaucoma

d. papilledema

e. SAH

Cause of notable fundoscopic finding:

Absent red reflex.

a. cataract

b. increased ICP

c. glaucoma

d. papilledema

e. SAH

Cause of notable fundoscopic finding:

Abnormal cup-disc ratio (>0.5).

a. cataract

b. increased ICP

c. glaucoma

d. papilledema

e. SAH

Cause of notable fundoscopic finding:

Absent venous pulsations.

a. cataract

b. increased ICP

c. glaucoma

d. papilledema

e. SAH

What is the term used for the overuse of triptans in migraine HA?

a. rebound migraine

b. tachyphylaxis

c. unresponsive migraine

d. none of the above

True or false:

Peripheral vertigo involves the brainstem or cerebellum, while central vertigo involves the vestibular system.

True or false:

Central vertigo patients always require a referral.

A 44 y/o presents w/ benign paroxysmal positional vertigo (BPPV). She probably has:

a. mild hearing loss

b. ringing in her ears

c. negative Dix-Hallpike

d. nausea and/or vomiting

Choose the common features of neuropathy: (select all that apply)

a. symmetrical

b. asymmetrical

c. dull ache

d. burning, weak feeling

e. variable course w/ rapid progression

f. predictable course w/ slow progression

g. affects proximal, upper extremities

h. affects distal, lower extremities

What are the 3 key features of PD?

a. pill-rolling tremor, dizziness, rigidity

b. pill-rolling tremor, bradykinesia, rigidity

c. bradykinesia, dizziness, orthostatic hypotension

d. bradykinesia, mask-like facies, orthostatic hypotension

True or false:

A benign essential tremor (ET) is common in the legs.

What are the 2 drugs that are most effective in tx ET?

a. propranolol and levadopa

b. levadopa and primidone

c. propranolol and primidone

d. levadopa and amlodipine

A 72 y/o female describes intermittent facial pain along the right side of her face and head. It is sharp and started last night. Her neuro exam is WNL. Which statement is correct?

a. She should have a CT of the brain

b. This is classic shingles

c. She should be given prednisone ASAP for 10 days

d. This is trigeminal neuralgia involving the 5th CN

Which CN?:

Supplies motor fibers to the muscles of the tongue.

Which CN?:

Responsible for sense of smell. Not routinely tested.

Which CN?:

Tested w/ the Snellen Chart (distant vision)

Which CN?:

Motor nerve supplying the sternoclediomastoid and trapezius muscles.

Which CN?:

Supplies parasympathetic fibers to the viscera of the chest and abdomen. Supplies motor fibers to the pharynx, larynx. Supplies sensory fibers to the ears, meninges, and viscera.

Which CN?:

Controls most eye movements, pupillary constriction, and accomodation.

Which CN?:

Responsible for movement of the superior oblique muscle.

Which CN?:

Supplies sensation to the face, nasal and buccal mucosa, teeth, and is responsible for mastication.

Which CN?:

Responsible for movement of the lateral rectus muscle (6 cardinal directions).

Which CN?:

Supplies sensation to the posterior 1/3 of the tongue, the pharynx, and the TM.

Which CN?:

Responsible for hearing, balance, and awareness of position.

Which CN?:

Innervates the facial muscles and supplies taste to the anterior 2/3 of the tongue.

Staphylococcus is typically a _____ bug and is a gram _____ organism.

a. urinary tract; positive

b. throat; positive

c. skin; positive

d. lung; positive

Streptococcus is typically a _____ bug and is a gram _____ organism. (select all that apply)

a. urinary tract; positive

b. throat; positive

c. skin; positive

d. lung; positive

Enterococcus is typically a _____ bug and is a gram _____ organism.

a. urinary tract; positive

b. throat; positive

c. skin; positive

d. lung; positive

When is it safe to give a cephalosporin to a pt who claims a PCN allergy?

a. when the PCN reaction was IgE mediated

b. when the PCN reaction was morbilliform rash

c. when the PCN reaction was hives

d. it is NEVER safe to give a cephalosporin to a pt w/ a claimed PCN allergy

What are the characteristics of a morbilliform rash? (select all that apply)

a. usually not pruitic

b. more prevalent in children

c. consist of wheals

d. consist of macular or maculopapular lesions

e. more common with aminopenicillins

f. pruitic

Gram positive or gram negative?:

MRSA.

Gram positive or gram negative?:

MSSA.

Gram positive or gram negative?:

DRSP.

What bug will PCNs not kill even though it's gram positive?

a. stept A, B, C, G

b. strept pneumoniae

c. DRSP

d. staph

What bug will augmentin not kill even though it's gram positive?

a. s. pneumoniae

b. MRSA

c. DRSP

d. MSSA

How long do you tx a pt w/ augmentin for prophylaxis of an infection resulting from a dog/cat bite?

a. 3-5 days

b. 7-10 days

c. 10-14 days

d. you don't tx w/ augmentin

Which medication would cover MRSA (gram +), MSSA (gram +), and gram negative bugs?

a. Amoxicillin

b. Augmentin

c. Bactrim

d. Keflex

In addition to levofloxacin, which other medication is considered first-line for acute bacterial prostatits?

a. Amoxicillin

b. Augmentin

c. Bactrim

d. Keflex

What bugs do tetracyclines tx? (select all that apply)

a. gram -

b. gram +

c. atypicals

d. MRSA

e. MSSA

If azithromycin cannot be used for chlamydia or CAP, which medication could be used instead?

a. doxycycline

b. augmentin

c. bactrim

d. penicillin

True or false:

Keflex can be used for gram + and gram - bugs.

Which medication would be a good choice for non-purulent skin and suture infections?

a. penicillin

b. bactrim

c. doxycycline

d. keflex

A pt was tx 10 days ago for otitis media and sinusitis with amoxicillin but has returned with the same sx. How should this pt be tx?

a. repeat the course of amoxicillin at a higher dose

b. switch to penicillin K

c. give doxycycline

d. give a 2nd generation cephalosporin

A pt was tx 10 days ago for otitis media and sinusitis with amoxicillin but has returned with the same sx. How should this pt be tx?

a. repeat the course of amoxicillin at a higher dose

b. switch to penicillin K

c. give a 3rd generation cephalosporin

d. give a 2nd generation cephalosporin

Which medication is an extended spectrum 3rd generation cephalosporin and is considered first-line for gonorrhea and epididymitis in sexually active men <35 y/o?

a. cefadroxil (duricef)

b. cefprozil (cefzil)

c. cefixime (suprax)

d. ceftriaxone (rocehpin)

True or false:

It is considered good practice to give azithromycin for strep throat.

What bugs can cipro (2nd generation fluoroquinolone) cover?

a. gram - and atypicals

b. gram + and atypicals

c. gram - and gram +

d. gram + only

What medication is considered first-line for acute bacterial prostatitis, traveler's diarrhea, and diverticulitis?

a. cipro (2nd generation fluoroquinolone)

b. azithromycin (later generation macrolide)

c. levaquin (respiratory fluoroquinolone)

d. erythromycin (early generation macrolide)

What medication is considered first-line for DRSP, acute bacterial prostatitis, and non-gonococcal epididymitis?

a. cipro

b. azithromycin

c. levaquin

d. erythromycin

True or false:

Moxifloxacin (Avelox) can be used to tx bugs that affect the lungs and the urinary tract.

Which bugs do metronidazole (flagyl) cover?

a. gram + and anaerobes

b. anaerobes only

c. gram - and anaerobes

d. gram - only

In addition to c. diff, which conditions can flagyl tx? (select all that apply)

a. UTI

b. BV

c. diverticulitis

d. CAP

e. PID

f. trichomoniasis

g. non-gonococcal urethritis

Why do we not use lincosamides (clindamycin) often?

a. the resistance is high

b. it has poor coverage

c. the AEs are sometimes VERY bad

d. all of the above

True or false:

IV vancomycin is not used for c. diff, only oral vancomycin.

Which vague sx should make you consider asking questions about depression? (select all that apply)

a. HA

b. backpain

c. insomnia

d. chronic pain

e. acute pain

f. constant fatigue

g. pyrosis

Which screening tool for depression is the most commonly used?

a. PHQ-9

b. PHQ-2

c. Beck's Depression Inventory

d. Zung Self-rating Depression Scale

Which labs should be included in a depression w/u?

a. TSH, CBC, U/A, glucose, B12, folate

b. CBC, U/A, glucose

c. TSH, U/A, glucose, B12, folate

d. CBC, B12, glucose

True or false:

To dx MDD, pts must exhibit 2-4 of the 8 sx but the sx do not need to be present everyday.

Which medication class is considered first-line in a pt who has MDD?

a. atypical antidepressant (bupropion- wellbutrin, mirtazapine- remeron)

b. tricyclic antidepressant (amitriptyline- elavil)

c. SSRI (sertraline- zoloft, fluoxetine- prozac, paroxetine- paxil)

d. SNRI (duloxetine- cymbalta, venlafaxine- effexor)

Which medication class is considered first-line in a pt who has mild-moderate depression?

a. atypical antidepressant (bupropion- wellbutrin, mirtazapine- remeron)

b. tricyclic antidepressant (amitriptyline- elavil)

c. SSRI (sertraline- zoloft, fluoxetine- prozac, paroxetine- paxil)

d. SNRI (duloxetine- cymbalta, venlafaxine- effexor)

Which medication class is considered first-line in an elderly pt who has been dx w/ moderate depression?

a. atypical antidepressant (bupropion- wellbutrin, mirtazapine- remeron)

b. tricyclic antidepressant (amitriptyline- elavil)

c. SSRI (sertraline- zoloft, fluoxetine- prozac, paroxetine- paxil)

d. SNRI (duloxetine- cymbalta, venlafaxine- effexor)

In an adolescent or young/middle aged adult, when should the pt expect to see "early" results after initiating a medication for depression?

a. 2-4 weeks

b. 4-6 weeks

c. 6-12 weeks

d. 12-16 weeks

In an adolescent or young/middle aged adult, when should the pt expect to see relief of sx after initiating a medication for depression?

a. 2-4 weeks

b. 4-6 weeks

c. 6-12 weeks

d. 12-16 weeks

In an elderly adult, when should the pt expect to see "early" results after initiating a medication for depression?

a. 2-4 weeks

b. 4-6 weeks

c. 6-12 weeks

d. 12-16 weeks

In an elderly adult, when should the pt expect to see relief of sx after initiating a medication for depression?

a. 2-4 weeks

b. 4-6 weeks

c. 6-12 weeks

d. 12-16 weeks

A 75 y/o female was dx w/ depression and started on sertraline (usual dose 50-200mg daily). What dosage would be a good starting dose for this pt?

a. 25mg daily

b. 25mg BID

c. 50mg daily

d. 100mg daily

TCA use for tx of depression has declined drastically in the past 12-15 years. SSRIs are more commonly prescribed now. This is d/t:

a. cost

b. efficacy

c. safety

d. ease of use

A 74 y/o pt has sx of depression. Sertraline is being considered. Which dx studies might be most important to order?

a. ECG, B12, folate

b. B12, folate, TSH

c. CBC, B12, folate

d. LFTs, B12, folate, CBC, TSH

Which medication has the lowest rate of sexual dysfunction when used in a pt being tx for depression?

a. paroxetine (paxil)

b. bupropion (wellbutrin)

c. duloxetine (cymbalta)

d. venlafaxine (effexor)

True or false:

Physiological reflux occurs after eating, is short-lived, and rarely occurs at night.

True or false:

Pathological GERD sx are often sometimes mistaken for MI sx.

Which medication should be given for the fastest relief of GERD sx?

a. antacids

b. H2 antagonists

c. PPIs

d. misoprostol

Which medication should be given for GERD sx if antacids alone are not helpful?

a. antacids

b. H2 antagonists

c. PPIs

d. misoprostol

Which medication can be used PRN for GERD sx? (select all that apply)

a. antacids

b. H2 antagonists

c. PPIs

d. misoprostol

Which medication should be given if antacids and H2 antagonists are ineffective against GERD sx?

a. antacids

b. H2 antagonists

c. PPIs

d. misoprostol

A stool specimen is + for leukocytes. This may be associated w/: (select all that apply)

a. bleeding

b. infection

c. inflammation

d. salmonella infection

e. IBS

f. Crohn's dz

g. UC

True or false:

Colon polyps develop quickly into colorectal cancer and should be removed as soon as they are found.

What dx test is considered the gold standard for colorectal cancer screening?

a. gFOBT

b. FIT DNA (cologuard)

c. colonoscopy

d. flex sigmoidoscopy

What is the problem w/ consistently elevated AST/ALT levels?

a. you are losing too many liver cells

b. you are not excreting well

c. you can develop hepatitis

d. all of the above

What is the problem w/ consistently elevated alkaline phosphate levels?

a. you are losing too many liver cells

b. you are not excreting well

c. you can develop hepatitis

d. all of the above

What could cause elevated ALT levels?

a. hepatitis

b. ETOH

c. drugs

d. liver dz

What could cause elevated AST levels? (select all that apply)

a. hepatitis

b. ETOH

c. drugs

d. liver dz

True or false:

HBsAg and anti-HBs will NEVER be + at the same time.

True or false:

HBsAg and anti-HBs cannot be + at the same time.

What does this mean?

- HBsAg

- anti-HBs

- anti-HBc

What does this mean?

- HBsAg

+ anti-HBs

- anti-HBc

What does this mean?

+ HBsAg

- IgM anti-HBc

- anti-HBs

+ anti-HBc

What does this mean?

- HBsAg

+ anti-HBs

+ anti-HBc

What does this mean?

+ HBsAg

- anti-HBs

+ anti-HBc

+ IgM anti-HBc

What condition causes elevated billirubin but normal LFTs?

a. diverticulitis

b. hepatitis

c. Gilbert's dz

d. cholecystitis

e. pancreatitis

f. appendicitis

g. bowel obstruction

What condition causes LLQ pain, is dx definitively via abdominal CT, and tx w/ cipro + metronidazole?

a. diverticulitis

b. hepatitis

c. Gilbert's dz

d. cholecystitis

e. pancreatitis

f. appendicitis

g. bowel obstruction

What condition causes a + McBurney's point pain and dx definitively w/ an abdominal CT?

a. diverticulitis

b. hepatitis

c. Gilbert's dz

d. cholecystitis

e. pancreatitis

f. appendicitis

g. bowel obstruction

What condition causes URQ pain, + Murphy's sign, initially investigated via U/S, and definitively dx if U/S is inconclusive via HIDA-scan?

a. diverticulitis

b. hepatitis

c. Gilbert's dz

d. cholecystitis

e. pancreatitis

f. appendicitis

g. bowel obstruction

What condition is characterized by abdominal pain associated w/ a dilated loop of bowel and d via flat, upright abdominal XR?

a. diverticulitis

b. hepatitis

c. Gilbert's dz

d. cholecystitis

e. pancreatitis

f. appendicitis

g. bowel obstruction

What condition is characterized by elevated triglycerides and acute abdominal pain, esp in the ULQ, dx via elevated amylase and lipase labs?

a. diverticulitis

b. hepatitis

c. Gilbert's dz

d. cholecystitis

e. pancreatitis

f. appendicitis

g. bowel obstruction

What condition causes tinkling bowel sounds and abdominal pain, dx via flat, upright abdominal XR?

a. diverticulitis

b. hepatitis

c. Gilbert's dz

d. cholecystitis

e. pancreatitis

f. appendicitis

g. bowel obstruction

What does this mean?

- blood

+ nitrites

+ leukocytes

What does this mean?

- blood

- nitrites

+ leukocytes

What does this mean?

+ blood

- nitrites

- leukocytes

What does this mean?

- blood

- nitrites

- leukocytes

but c/o increased frequency and urgency

How long should you tx a non-pregnant female pt w/ an uncomplicated UTI who has no co-morbid conditions?

a. 1 day

b. 3 days

c. 5 days

d. 7-10 days

How long should you tx a non-pregnant female pt w/ an uncomplicated UTI who has diabetes?

a. 1 day

b. 3 days

c. 5 days

d. 7-10 days

How long should you tx a male pt w/ an uncomplicated UTI who has no co-morbid conditions?

a. 1 day

b. 3 days

c. 5 days

d. 7-10 days

How long should you tx a male pt w/ a complicated UTI who has no co-morbid conditions?

a. 1 day

b. 3 days

c. 5 days

d. 7-10 days

What does this mean?

Hyaline casts in urine.

a. low urine flow or dehydration

b. no clinical significance

c. always pathological (glomerulonephritis, UT injury)

d. inflammation (nephritis, pyelonephritis)

e. acute tubular necrosis or hepatitis

What does this mean?

Epithelial casts in urine.

a. low urine flow or dehydration

b. no clinical significance

c. always pathological (glomerulonephritis, UT injury)

d. inflammation (nephritis, pyelonephritis)

e. acute tubular necrosis or hepatitis

What does this mean?

Crystal casts in urine.

a. low urine flow or dehydration

b. no clinical significance

c. always pathological (glomerulonephritis, UT injury)

d. inflammation (nephritis, pyelonephritis)

e. acute tubular necrosis or hepatitis

What does this mean?

WBC casts in urine.

a. low urine flow or dehydration

b. no clinical significance

c. always pathological (glomerulonephritis, UT injury)

d. inflammation (nephritis, pyelonephritis)

e. acute tubular necrosis or hepatitis

What does this mean?

RBC casts in urine.

a. low urine flow or dehydration

b. no clinical significance

c. always pathological (glomerulonephritis, UT injury)

d. inflammation (nephritis, pyelonephritis)

e. acute tubular necrosis or hepatitis

Which STI/vaginal infection?

Screening test is ELISA first, then confirmatory Western Blot.

a. HIV

b. BV

c. trichomoniasis

d. syphillis

e. herpes

f. gonorrhea

g. chlamydia

h. PID

Which STI/vaginal infection?

+ "Chandelier Test." Tx w/ IM rocephin + PO doxy 100mg BID x14d.

a. HIV

b. BV

c. trichomoniasis

d. syphillis

e. herpes

f. gonorrhea

g. chlamydia

h. PID

Which STI/vaginal infection?

Produces malodorous d/c, + Whiff test, and clue cells. Tx w/ metronidazole 500mg BID x7d.

a. HIV

b. BV

c. trichomoniasis

d. syphillis

e. herpes

f. gonorrhea

g. chlamydia

h. PID

Which STI/vaginal infection?

Produces a painless chancre, possible rash on palms/soles.

a. HIV

b. BV

c. trichomoniasis

d. syphillis

e. herpes

f. gonorrhea

g. chlamydia

h. PID

Which STI/vaginal infection?

RPR used for screening. FTA-ABS, MHA-TP used for dx. Tx w/ 2.4m units of PCN IM for early dz; 3 doses of benzathine PCN qweekly for later dz.

a. HIV

b. BV

c. trichomoniasis

d. syphillis

e. herpes

f. gonorrhea

g. chlamydia

h. PID

Which STI/vaginal infection?

May be associated w/ involuntary weight loss and repeated viral/bacterial infections.

a. HIV

b. BV

c. trichomoniasis

d. syphillis

e. herpes

f. gonorrhea

g. chlamydia

h. PID

Which STI/vaginal infection?

Tx w/ 2g metronidazole as a single dose. Wet prep used for dx.

a. HIV

b. BV

c. trichomoniasis

d. syphillis

e. herpes

f. gonorrhea

g. chlamydia

h. PID

Which STI/vaginal infection?

Etiologic agent is a virus.

a. HIV

b. BV

c. trichomoniasis

d. syphillis

e. herpes

f. gonorrhea

g. chlamydia

h. PID

Which STI/vaginal infection?

DNA probe used for screening. Produces a d/c. Tx w/ IM rocephin + 1g PO azithromycin as a single dose.

a. HIV

b. BV

c. trichomoniasis

d. syphillis

e. herpes

f. gonorrhea

g. chlamydia

h. PID

Which STI/vaginal infection?

DNA probe used for screening. Produces a d/c. Tx w/ 1g PO azithromycin as a single dose.

a. HIV

b. BV

c. trichomoniasis

d. syphillis

e. herpes

f. gonorrhea

g. chlamydia

h. PID

Which STI/vaginal infection?

Produces vesicles on mucous membranes. Tx w/ acyclovir (or similar antiviral).

a. HIV

b. BV

c. trichomoniasis

d. syphillis

e. herpes

f. gonorrhea

g. chlamydia

h. PID

According to JNC-8, when should pharmacotherapy begin for a pt <60 y/o or has CM or CKD?

a. when BP exceeds 130/90

b. when BP exceeds 140/90

c. when BP exceeds 150/90

d. all of the above

According to JNC-8, when should pharmacotherapy begin for a pt >60 y/o?

a. when BP exceeds 130/90

b. when BP exceeds 140/90

c. when BP exceeds 150/90

d. all of the above

According to JNC-8, a pt who is <60 y/o or has DM or CKD should maintain a BP of =/<:

a. 130/90

b. 140/90

c. 150/90

d. 120/80

According to JNC-8, a pt who is >60 y/o should maintain a BP of =/<:

a. 130/90

b. 140/90

c. 150/90

d. 120/80

According to JNC-8, what is the best initial choice of medication for HTN in an AA w/ or w/o DM?

a. thiazide diuretic

b. CCB

c. ACE

d. ARB

According to JNC-8, what is the best initial choice of medication for non-black pt w/ or w/o DM?

a. thiazide diuretic

b. CCB

c. ACE

d. ARB

According to JNC-8, which anti-HTN med can drop BP >10 points?

a. thiazide diuretic

b. CCB

c. ACE

d. ARB

According to JNC-8, which anti-HTN med can drop BP 2-8 points?

a. thiazide diuretic

b. CCB

c. ACE

d. ARB

True or false:

ACEIs and ARBs are safe to take together.

Which medication for HTN should be avoided in pts w/ a reported sulfa allergy?

a. lisinopril

b. losartan

c. amlodipine

d. HCTZ

What is the goal BP for an 80 y/o woman w/ multiple co-morbidities, including CAD w/ stent and hyperlipidemia?

a. <130/80

b. <140/90

c. <150/80

d. <150/90

A 75 y/o pt reports to your office with consistently elevated systolic BP. She takes fosinopril 10mg w/ HCTZ 12.5mg in the AM. Which medication would be best to add?

a. lisinopril

b. metoprolol

c. amlodipine

d. increase HCTZ

How much amlodipine would be appropriate for initial tx of ISH in an 80 y/o woman if the normal starting dose is 5mg?

a. 1.25mg daily

b. 2.5mg daily

c. 5mg BID

d. 10mg BID

An 80 y/o pt w/ HTN takes the following meds: fosamax, pravastatin, fosinopril (10mg), HCTZ (12.5mg), amlodipine (2.5mg), and naproxen. Her eGFR = 50 today. How should this be handled? (select all that apply)

a. don't worry about it

b. increase HCTZ

c. increase fluids

d. stop naproxen

e. add candesartan

f. stop amlodipine

g. nothing can be done

Which medication should be used w/ caution in pts w/ gout?

a. irbesartan

b. HCTZ

c. amlodipine

d. metoprolol

Which medication should be a part of a pt's medication list if the pt has a hx of MI?

a. irbesartan

b. HCTZ

c. amlodipine

d. metoprolol

An increase in which medication should cause you to monitor BUN, Cr, K+, and BP?

a. irbesartan

b. HCTZ

c. amlodipine

d. metoprolol

An increase in which medication should cause you to monitor HR and BP?

a. irbesartan

b. HCTZ

c. amlodipine

d. metoprolol

Which medication is considered first-line for pt's w/ hyperlipidemia w/ hx of MI and DM?

a. ezetimibe (zetia)

b. pravastatin

c. fenofibrate

d. niacin ER

e. fish oil OTC

What can cause elevated TGs? (select all that apply)

a. taking lisinopril

b. ETOH use

c. elevated glucose/A1C

d. consumption of red meat

e. fish oil

Which medications in a pt w/ HTN and CHF should be discontinued after several exacerbations of HF in the past few months? (select all that apply)

a. irbesartan 300mg daily

b. HCTZ 12.5mg daily

c. tamsulosin daily

d. amlodipine 5mg daily

e. metoprolol 50mg daily

f. aspirin 81mg daily

g. metformin 1000mg BID

h. pioglitazone (Actos) 30mg daily

i. naproxen 500mg PRN

Which murmur?:

Systolic in nature. Best heard at aortic listening point. Usually affects ages 15-65 y/o as a result of a congenital defect or c/b rheumatic fever. Can be assoc w/ findings of angina, syncope, and CHF (later in life).

a. aortic stenosis

b. aortic regurg

c. mitral stenosis

d. mitral regurg

e. mitral valve prolapse

Which murmur?:

Diastolic in nature. Best heard at aortic listening point. Result of a congenital defect, rheumatic heart dz, aortic root abnormalities, or syphillis. Can be assoc w/ findings of angina, dizziness, HF, and chest pain.

a. aortic stenosis

b. aortic regurg

c. mitral stenosis

d. mitral regurg

e. mitral valve prolapse

Which murmur?:

Systolic in nature. Best heard at the mitral listening point. Usually affects women 14-30 y/o. Most are asymptomatic. Can be assoc w/ findings of chest pain, palpitations, and a "Click."

a. aortic stenosis

b. aortic regurg

c. mitral stenosis

d. mitral regurg

e. mitral valve prolapse

Which murmur?:

Systolic in nature. Best heard at the apex of the heart. Result of a congenital defect or c/b rheumatic fever, acute endocarditis or MVP. Can be assoc w/ findings of angina, syncope, and CHF (later in life).

a. aortic stenosis

b. aortic regurg

c. mitral stenosis

d. mitral regurg

e. mitral valve prolapse

Which murmur?:

Diastolic in nature. Best heard at the mitral listening point. C/b rheumatic fever. Can be assoc w/ findings of dyspnea and a-fib after a long period of being asymptomatic.

a. aortic stenosis

b. aortic regurg

c. mitral stenosis

d. mitral regurg

e. mitral valve prolapse

A 67 y/o pt c/o pain in her right lower leg when walking. She gets complete relief when she stops walking and rests. It has worsened over the past 3 months. What finding is likely?

a. weakened R pedal pulse

b. LE edema

c. cough and abnormal CXR

d. diminished breath sounds

What is the most common side effect of amlodipine?

a. HF

b. rash

c. LE edema

d. cough

An 80 y/o pt has a systolic murmur that is best heard at the apex of the heart. What murmur is most likely?

a. mitral stenosis

b. aortic stenosis

c. mitral regurg

d. aortic regurg

A 65 y/o c/o sternal discomfort when walking and presents w/ a soft murmur near the 2nd ICS to the R of the sternum. It is audible during systole. What murmur is this?

a. aortic regurg

b. mitral valve prolapse

c. mitral stenosis

d. aortic stenosis

A 72 y/o male pt w/ a BMI of 35 has been dx w/ T2DM. His A1C is 8.2. What is the NP's INITIAL action?

a. initiate metformin

b. discuss lifestyle modifications

c. assess for complications of DM

d. establish a target A1C goal

What is the appropriate A1C goal for most young-middle adults w/ T2DM?

a. <7

b. <8

c. <6

d. 5-6

What is the appropriate A1C goal for most pregnant pts w/ T2DM?

a. <7

b. <8

c. <6

d. 5-6

What is the appropriate A1C goal for most young-middle adults w/ T1DM?

a. <7

b. <8

c. <6

d. 5-6

What is the appropriate A1C goal for older adults w/ T2DM?

a. <7

b. <8

c. <6

d. 5-6

Which medications are associated w/ an increased risk of developing T2DM? (select all that apply)

a. glucocorticoids

b. amlodipine

c. HCTZ

d. atypical antipsychotics (i.e. Zyprexa, clozaril, seroquel, risperdal, latuda, abilify, geodon)

e. niacin

f. HMG Co-A reductase inhibitors (statins = atorvastatin)

How much can exercise of at least 8 weeks' duration lower a pt's A1C?

a. 0.2%

b. 0.4%

c. 0.6%

d. 0.8%

What is the only system in the body not affected by DM?

a. CV

b. integumentary

c. nervous

d. respiratory

With which conditions could you safely prescribe metformin for a pt w/ T2DM? (select all that apply)

a. active hepatitis

b. eGFR >60

c. eGFR = 50

d. stage 1 HF

e. binge drinking

What are the 2 most common AEs of metformin?

a. diarrhea and flatulence

b. constipation and flatulence

c. diarrhea and headache

d. constipation and headache

With a metformin dose of 1000mg BID, how much should a pt's A1C be expected to decrease over the next 3 months?

a. 0.25%

b. 0.5%

c. 1-2%

d. 3%

The primary MOA for metformin is:

a. decr hepatic glucose production

b. incr insulin production

c. slows intestinal absorption of carbs

d. increases insulin sensitivity

Which diabetes med?:

Includes meds that end w/ "gliptin." Slow inactivation of incretin hormones = lowers BG. Not first-line for monotherapy. Can be used in combo. Reduces A1C about 0.7%. Expensive.

a. biguanides

b. sulfonylurea

c. meglitinides

d. DPP-4 inhibitors

e. GLP-1s

f. TZDs

g. SGLT2s

Which diabetes med?:

Includes metformin. Decreases hepatic glucose production. First-line for monotherapy. Can be used in combo. Reduces A1C about 1-2%. No hypoglycemia. Few AEs. Cheap.

a. biguanides

b. sulfonylurea

c. meglitinides

d. DPP-4 inhibitors

e. GLP-1s

f. TZDs

g. SGLT2s

Which diabetes med?:

Includes meds that end w/ "gliflozin" (ex. canagliflozin- Invokana, dapagliflozin- Farxiga). Prevents renal reabsorption of glucose/promotes its excretion. Used in combo. AEs: UTI, yeast inf. Pts often lose weight. VERY expensive.

a. biguanides

b. sulfonylurea

c. meglitinides

d. DPP-4 inhibitors

e. GLP-1s

f. TZDs

g. SGLT2s

Which diabetes med?:

Includes meds that begin w/ G, end in "ide" (ex. glipizide- Glucotrol). Potentiate insulin secretion. Not first-line for monotherapy. Can be used in combo. May cause hypoglycemia and wt gain. Reduces A1C about 1-2%. Cheap.

a. biguanides

b. sulfonylurea

c. meglitinides

d. DPP-4 inhibitors

e. GLP-1s

f. TZDs

g. SGLT2s

Which diabetes med?:

Includes meds that end w/ "glitazone" (ex. pioglitazone- Actos, rosiglitazone- Avandia). Preserves beta cell function/improves insulin insensitivity. Can be used in combo. Contraindicated in HF. Reduces A1C about 0.7%. Kind of expensive.

a. biguanides

b. sulfonylurea

c. meglitinides

d. DPP-4 inhibitors

e. GLP-1s

f. TZDs

g. SGLT2s

Which diabetes med?:

Includes meds that end w/ "glinide" (ex. repaglinide- Prandin, nateglinide- Starlix). Stimulates beta cell insulin release. Not first-line for monotherapy. Can be used in combo.

a. biguanides

b. sulfonylurea

c. meglitinides

d. DPP-4 inhibitors

e. GLP-1s

f. TZDs

g. SGLT2s

Which diabetes med?:

Includes meds that end w/ "tide" (ex. exenatide- Byetta, liraglutide- Victoza, dulaglutide- Trulicity). Glucagon-like peptide. Not first-line for monotherapy. Can be used in combo. Reduces A1C about 1-1.5%. Almost no hypoglycemia. Pts often lose wt.

a. biguanides

b. sulfonylurea

c. meglitinides

d. DPP-4 inhibitors

e. GLP-1s

f. TZDs

g. SGLT2s

How should the following pt be handled?:

35 y/o female w/ A1C of 5.9%, newly dx w/ IFG.

a. metformin (biguanide)

b. Glucotrol-glipizide (sulfonylurea)

c. Victoza- liraglutide (GLP-1)

d. Actos- pioglitazone (TZD)

e. insulin

f. dual therapy

How should the following pt be handled?:

55 y/o female w/ A1C of 9.2%, dx w/ T2DM 6 weeks ago. A1C goal = <7%. Intolerant of metformin (biguanide).

a. metformin (biguanide)

b. Glucotrol-glipizide (sulfonylurea)

c. Victoza- liraglutide (GLP-1)

d. Actos- pioglitazone (TZD)

e. insulin

f. dual therapy

How should the following pt be handled?:

79 y/o male w/ A1C of 9.5%, newly dx w/ T2DM. A1C goal = <8%. Need to avoid polypharmacy and hypoglycemia d/t age.

a. metformin (biguanide)

b. Glucotrol-glipizide (sulfonylurea)

c. Victoza- liraglutide (GLP-1)

d. Actos- pioglitazone (TZD)

e. insulin

f. dual therapy

How should the following pt be handled?:

62 y/o female w/ A1C of 7.9%. A1C goal = <7%. Taking metformin. On a fixed budget.

a. metformin (biguanide)

b. Glucotrol-glipizide (sulfonylurea)

c. Victoza- liraglutide (GLP-1)

d. Actos- pioglitazone (TZD)

e. insulin

f. dual therapy

How should the following pt be handled?:

27 y/o male w/ A1C of 6.9%, newly dx w/ T2DM.

a. metformin (biguanide)

b. Glucotrol-glipizide (sulfonylurea)

c. Victoza- liraglutide (GLP-1)

d. Actos- pioglitazone (TZD)

e. insulin

f. dual therapy

How should the following pt be handled?:

35 y/o female w/ A1C of 6%, newly dx w/ IFG. Contemplating pregnancy.

a. metformin (biguanide)

b. Glucotrol-glipizide (sulfonylurea)

c. Victoza- liraglutide (GLP-1)

d. Actos- pioglitazone (TZD)

e. insulin

f. dual therapy

How should the following pt be handled?:

35 y/o obese female w/ A1C of 8.9%. A1C goal = <7%. Has the "Cadillac" health insurance. Choose 3 meds.

a. metformin (biguanide)

b. Glucotrol-glipizide (sulfonylurea)

c. Victoza- liraglutide (GLP-1)

d. Actos- pioglitazone (TZD)

e. insulin

f. dual therapy

How should the following pt be handled?:

55 y/o female w/ A1C of 10.2%. A1C goal = <7%. Takes metformin + glipizide. If you stop the glipizide, what should you start?

a. metformin (biguanide)

b. Glucotrol-glipizide (sulfonylurea)

c. Victoza- liraglutide (GLP-1)

d. Actos- pioglitazone (TZD)

e. insulin

f. dual therapy

How should the following pt be handled?:

50 y/o male w/ A1C of 8%. A1C goal = <7%. Self-employed trucker who cannot risk hypoglycemia. Metformin is at the highest dose. He is on a limited budget.

a. metformin (biguanide)

b. Glucotrol-glipizide (sulfonylurea)

c. Victoza- liraglutide (GLP-1)

d. Actos- pioglitazone (TZD)

e. insulin

f. dual therapy

How should basal insulin be dosed when initiating it?

a. 0.1-0.2u/kg or 10u

b. 0.2-0.4u/kg or 20u

c. 0.4-0.8u/kg or 30u

d. depends on their age

True or false:

T3 is thyroxine and it has no affect on metabolism.

True or false:

TSH is produced by the anterior pituitary gland and is a messenger. It is significantly affected by even small changes in T4 and is therefore used for initial screening.

The sx of thyroid dz are:

a. very predictable

b. worsen quickly over time

c. never worsen over time

d. are very variable

The initial test to screen for thyroid dz should be:

a. T3

b. T4

c. TSH

d. thyroid panel

A 35 y/o pt c/o fatigue. A TSH is ordered and is resulted at 6.8 (H). What should be done next?

a. dx w/ hypothyroidism and consider replacement

b. dx w/ subclinical hypothyroidism

c. recheck TSH and T4

d. recheck TSH only

True or false:

Replacement w/ levothyroxine is based on the pt's actual body weight and age of the pt is not considered.

A 46 y/o c/o fatigue. TSH/T4 screening #1 = 13.5/1.1. TSH/T4 screening #2 = 15.6/0.9. What is your dx?

a. primary hypothyroidism

b. subclinical hypothyroidism

c. primary hyperthyroidism

d. subclinical hyperthyroidism

A 45 y/o pt has subclinical hypothyroidism, w/ a TSH of 6.2. What are the major risks of prescribing levothyroxine at this time?

a. there are few risks

b. hyperlipidemia and a-fib

c. accelerated bone loss and a-fib

d. HTN and tachycardia

A 55 y/o was dx w/ hypothyroidism 6 weeks ago. Labs 6 weeks ago = TSH 24.3, T4 0.2. She was started on 50mcg/d. Labs today = TSH 18.4. How should she be managed?

a. increase levothyroxine to 100mcg

b. increase levothyroxine to 75mcg

c. decrease levothyroxine to 25mcg

d. discontinue levothyroxine

Why do pts need to take levothyroxine on an empty stomach?

a. TSH will rise if taken w/ food d/t decreased absorption of medication

b. TSH will drop

c. there will be no effect on TSH

d. the pt could experience intense nausea if taken w/ food

What will happen if a pt takes 2 pills in one day instead of 1?

a. TSH will stay the same

b. TSH will drop

c. TSH will rise

d. any of these could happen

What is the BMI cut-off point for screening adults w/ one or more risk factors for DM?

a. 23

b. 24

c. 25

d. 26

A 35 y/o female was dx w/ hypothyroidism 6 weeks ago and is being replaced w/ 88mcg of levothyroxine. Based on a TSH today of 1.4, what should be done today.

a. increase the dose to 100mcg

b. increase the dose to 112mcg

c. decrease the dose

d. continue the same dose

A firm, smooth, and symmetrically enlarged prostate should make you think of:

a. prostate CA

b. BPH

c. acute bacterial prostatitis

d. ED

The most common clinical manifestation of BPH is:

a. urinary retention

b. LUTS

c. urinary frequency

d. UTI

A 78 y/o male is having LUTS. What finding would make you suspicious of something other than BPH? (select all that apply)

a. urinary retention

b. nodular prostate gland

c. asymmetrical enlargement

d. hematuria

e. elevated PSA

f. bacteria in urine

A 55 y/o pt has been dx w/ symptomatic BPH. His PSA level is 4 (H- normal range <2.5). What can cause a clinically SIGNIFICANT elevation in PSA? (select all that apply)

a. recent ejaculation

b. DRE

c. cycling

d. exercise

e. enlarged prostate

f. prostate infection

A 30 y/o pt has suspected acute bacterial prostatitis. What lab test should NOT be part of the initial evaluation?

a. PSA

b. U/A

c. urine culture

d. urethral swab

What is an appropriate choice of medication to tx acute bacterial prostatitis (non-gonococcal)? (select all that apply)

a. amoxicillin

b. bactrim

c. cipro

d. keflex

e. levofloxacin

How long should you treat acute bacterial prostatitis?

a. 2 weeks

b. 4 weeks

c. 6 weeks

d. 8 weeks

A 26 y/o has acute scrotal pain. He is dx w/ epididymitis. What is a likely finding?

a. the underlying cause is a hernia

b. he has a + cremasteric reflex

c. he has a swollen, tender scrotum

d. he has a fever

How should you tx non-infectious epididymitis?

How is an inguinal hernia most commonly dx?

a. U/S

b. CT of the abdomen

c. physical exam

d. U/S and CT

What is the only tx for a hernia?

a. truss

b. watchful waiting

c. surgical repair

d. antibiotics

How would you describe a pt's testicle who has a testicular torsion?

a. non-tender, low-riding

b. tender, high-riding

c. tender, swollen

d. hard, non-tender

How quickly must a testicular torsion be tx to avoid ischemia and irreversible damage?

a. 4-6 hours

b. 6-8 hours

c. 8-10 hours

d. 10-12 hours

How is a testicular torsion definitively dx?

a. CT scan

b. MRI

c. U/S

d. Physical exam

A hx of cryptochidism, even if repaired, puts a male at a higher risk of:

a. testicular torsion

b. epididymitis

c. testicular cancer

d. prostate cancer

Primary or secondary dysmenorrhea?:

C/b excessive prostaglandins and usually begins in adolescence.

Primary or secondary dysmenorrhea?:

Pain begins 1-2 days prior to menses and usually resolves over 12-72 hours. Improves w/ NSAIDs, hormonal contraceptives, age and parity.

Primary or secondary dysmenorrhea?:

C/b endometriosis, fibroids, infection/PID, etc. Usually begins after 25 y/o.

Primary or secondary dysmenorrhea?:

Sx worsen over time and usually do not respond to typical analgesics.

What is the least likely cause of secondary dysmenorrhea?

a. endometriosis

b. PID

c. fibroids

d. UTI

True or false:

All infertile PCOS pts should start w/ clomiphene if trying to become pregnant.

When should a pt first receive a Pap Screen?

a. 19 y/o

b. 21 y/o

c. 25 y/o

d. after first sexual encounter

A pt has been dx w/ BV. Which choices are possible risk factors? (select all that apply)

a. new sexual partner

b. no condom use

c. douching

d. copper IUD

e. high vit D levels

f. inadequate dairy intake

You have just dx a 34 y/o pt w/ vulvovaginal candidasis. She states that her vaginal sx are making her "miserable." What could provide relief w/in a few hours?

a. vaginal anti-fungal cream

b. fluconazole (diflucan) 150mg

c. boric acid suppository

d. yogurt douche

Which T-score reflects a pt w/ osteopenia?

a. =/< 0.5-1

b. between -1 and -2.5

c. -2.5 or less

d. >2.5

What is the benefit of a breast U/S when a pt has found a lump?

a. it is cheaper

b. it is quicker

c. it differentiates a fluid-filled cyst from a solid mass

d. all of the above

At what age should annual mammograms for breast CA begin?

a. 35

b. 40

c. 45

d. 50

OA or RA?:

Primarily, symmetrically affects joints in the hands and metacarpophalageal. Heberden's Nodes are absent.

OA or RA?:

Primarily, asymmetrically affects weight-bearing joints, carpometacarpal, and DIP joints. Heberden's Nodes are usually present.

OA or RA?:

Joints are described as bony and hard. Labs are all WNL.

OA or RA?:

Joints are described as soft, warm, and tender. Labs = + RF, + CCP, elevated ESR, elevated CRP.

OA or RA?:

Stiffness in the morning that typically resolves w/in 60 minutes. Pain exacerbated by activity and relieved w/ rest.

OA or RA?:

Morning stiffness that does not resolve w/in 60 minutes. Pain not relieved by rest.

OA or RA?:

Non-pregnant pts tx w/ methotrexate or sulfasalazine, corticosteroids, and NSAIDs initially.

OA or RA?:

Initially tx w/ exercise (ROM and strengthening), wt loss, heat, acetaminophen or NSAIDs.

OA or RA?:

Autoimmune in nature. Characterized by loss of bone mass, worn cartilage, and thickened/edematous synovial membrane.

OA or RA?:

Usually a product of aging. Characterized by joint space narrowing, bone loss, and bone spurs.

ACL or MCL test?:

McMurray's test.

ACL or MCL Test?:

Anterior drawer test, posterior drawer test, and Lachman test.

Which ortho condition is characterized by a + MTP Squeeze Test, causing pain/burning between the 3-4 toes?

a. DeQuervain's tenosynovitis

b. Bouchard's nodes

c. Baker's cyst

d. Morton's neuroma

Which ortho condition is characterized by a + Finkelstein Test and dorsal thumb pain?

a. DeQuervain's tenosynovitis

b. Bouchard's nodes

c. Baker's cyst

d. Morton's neuroma

Which ortho condition is characterized by nodes on PIP joints secondary to OA?

a. DeQuervain's tenosynovitis

b. Bouchard's nodes

c. Baker's cyst

d. Morton's neuroma

Which ortho condition is characterized by nodes on

DIP joints secondary to OA?

a. DeQuervain's tenosynovitis

b. Heberden's nodes

c. Baker's cyst

d. Morton's neuroma